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General NPI Number Information
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NPI Number | 1649787201
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Entity Type | Individual
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Provider Name | ANDREA DIANE ZUMMO FNP-BC, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 8204 LOUISIANA BLVD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1737
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Country | US
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Telephone | 505-582-2180
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30456
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City | ALBUQUERQUE
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State | NM
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Zip | 87190-0456
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 60693
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 60693
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License Number State | NM
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